Medical cannabis patients in the UK who receive social care packages from their local authority can apply to have their cannabis-based prescription medicines (CBPM) costs assessed as Disability Related Expenditure (DRE). If accepted, this may reduce the costs of their social care charges but does not cover costs of the cannabis prescription.
Understanding Social Care Charges
Under Section 14 of the Care Act 2014, local authorities can charge for social care, but they must ensure that such charges are fair and transparent. A financial assessment will determine what an individual can afford, factoring in:
- Savings and Capital
- State Pension, Pension Credit, ESA, UC, and Income Support
- Disability benefits, such as DLA or PIP (Care Components Only)
The assessment will disregard:
- The Minimum Income Guarantee (MIG), which ensures coverage for basic living costs like food, utilities, and transportation.
- Housing costs, including rent or mortgage, council tax, and building insurance.
- Verified Disability Related Expenditure (DRE), the extra costs associated with managing a health condition.
- Employment Related Income.
Claiming CBPM Costs as DRE
Patients can request that their CBPM prescription costs be considered DRE. While many councils have predefined checklists of eligible expenses, additional items may also be considered if supported by evidence. Local authorities must follow the Care Act 2014 principles, which include promoting individual wellbeing, social inclusion, and independence.
If prescription costs are not accepted as DRE, it could be considered a breach of the Act, especially if this impacts a patient’s wellbeing or independence.
Supporting Your Claim
To claim CBPM costs as DRE, patients must provide evidence demonstrating:
- That CBPM is a necessary treatment for their condition.
- That no effective alternative medications are available through the NHS.
Unfortunately, many councils may not accept evidence from medical cannabis prescribers and instead require support from a GP and/or healthcare consultant. Patients are encouraged to request a supporting letter from their GP or healthcare consultant, detailing the necessity of CBPM and its role in reducing other treatments, such as opioids.
If Your Claim Is Denied
If a local authority rejects your request to classify CBPM costs as DRE, you can:
- File a formal complaint with the council, following their internal complaints procedure.
- If unresolved, escalate the matter to the Local Government and Social Care Ombudsman (LGSCO), which will independently assess the case.
The Ombudsman can recommend remedies for councils to implement. While their recommendations are not legally binding, councils rarely refuse to comply. Ensure that all medical evidence is shared with the Council and the Ombudsman.
Example Case
In a recent case (LGSCO reference: 24 001 331), Brighton & Hove City Council was found at fault for mishandling a social care assessment. Patients can use such precedents to support their claims.
In the recent review by the Local Government and Social Care Ombudsman (LGSCO), significant concerns were raised regarding how a council handled a patient’s request to include medical cannabis costs as Disability Related Expenditure (DRE):
- Failure to Consider Medical Evidence: The patient, referred to as Ms. X, provided evidence that alternative medications posed serious health risks, including a recurrence of a condition she previously experienced. She also explained why other treatments were unsuitable. The council, however, appeared to disregard these critical points in its assessment.
- Lack of Transparency: The council claimed Ms. X’s cannabis medication costs were “unreasonable,” yet failed to provide a clear explanation or justification for its decision. The rationale for deeming the costs excessive was absent, leaving the patient in the dark about the decision-making process.
- Injustice to the Patient: The absence of a thorough and transparent review means Ms. X cannot be confident that her request was properly evaluated. This lack of consideration resulted in a clear injustice, undermining her right to fair treatment under the Care Act 2014.
Implications
This case highlights the importance of councils adhering to their legal duty to consider all relevant evidence and provide transparent justifications for their decisions. Patients who encounter similar challenges are encouraged to challenge such decisions through formal complaints and escalate them to the Ombudsman if necessary.
Key Takeaways
- Ensure your CBPM costs meet the criteria for DRE.
- Gather strong medical evidence, ideally from your GP and/or other healthcare consultants (not your cannabis prescriber).
- Be persistent and know your rights under the Care Act 2014.
For further guidance:
Local Government and Social Care Ombudsman: https://www.lgo.org.uk/
Care Act Statutory Guidance: https://www.gov.uk/government/publications/care-act-statutory-guidance/care-and-support-statutory-guidance
Medical Cannabis as Disability Related Expenditure Social Care Case Playlist by Cannabis is Medicine UK: https://www.youtube.com/playlist?list=PLmL0L5mPiFAUwDl6bG51wPOu-53MGGQMo
By understanding the process and advocating for your rights, you can ensure fair consideration of your medical cannabis prescription costs within your social care assessment.
The post Claiming Social Care Support for Medical Cannabis Patients in the UK first appeared on PatientsCann UK.
